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General NPI Number Information
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NPI Number | 1629133111
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Entity Type | Organization
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Legal Business Name | ANDALUSIA EYE CLINIC LLC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 1860 E THREE NOTCH ST
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City | ANDALUSIA
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State | AL
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Zip | 36421-2404
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Country | US
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Telephone | 334-222-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1517
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City | ANDALUSIA
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State | AL
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Zip | 36420-1226
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Country | US
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Telephone | 334-222-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES H TILLMAN JR.
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Credential | OD
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Telephone | 334-222-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 00025149
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S620TA088
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License Number State | AL
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